Using HCC Coding for Greater Reimbursement

by | Published on Apr 11, 2016 | Medical Coding

HCC Coding
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HCC coding is important for health practices to increase their reimbursement opportunities. Outsourcing to a professional medical billing and coding company could ensure that the coding is accurate and claims are submitted in a timely manner.

Making the Most of the HCC Opportunity

Hierarchical Condition Coding (HCC) could be a great opportunity to ensure greater reimbursement in Medicare Advantage (MA) plans and better patient care. Often, practices do not make the most of the opportunity at hand. That’s where a professional coder could make the difference. The HCC model has been used by Medicare since 2004 for calculating payments to healthcare providers, and physician practices need to make the most of this provision.

HCCs from Previous Health Plan, and Chart Reviews

It is important to identify if your new patients do have HCCs assigned from their previous health plan. If they have, then you must ensure that you maintain them since it will help you collect data comprehensively and ensure continuity of care.

Chart reviews are important for imparting education in documentation while in service. Common documentation errors identified in your chart review could be the chance for training physicians and other staff of your practice one-on-one.

Monitoring HCCs for Consistency

Each member’s HCC must be monitored for reporting consistency. Patients having dropping HCCs could indicate issues with care provided, but it could also mean that the provided services were not accurately documented. CMS expects proper documentation and assessment of the member’s condition each year, and it’s on the basis of the medical record documentation that the CMS reimburses since it indicated that resources were spent.

With smart tools you can track the diagnosis data for patients who have been terminated from your monthly eligibility reports. You can re-capture the revenue lost for those members, which really is a great asset.

Getting Rid of Encounter Data Backlog

While it often gets left out, it is important to ensure that you do not have a backlog of unprocessed encounter data. This tends to happen since payable claims are often given priority over encounters on account of federal regulations regarding timely claim payment.  Backlog of encounter data could detrimentally affect your revenue.

A professional coder must review the complete medical records received by your appeals department, so that any other diagnostic codes that could positively impact your HCC scores can be identified.

It is important to focus on HCC coding, so that you can make sure you have exploited all the opportunities for reimbursement that you would have left out on. And in this super competitive field of healthcare with increasing regulation and coding changes, this could prove vital for you to sustain your practice.

Natalie Tornese

Holding a CPC certification from the American Academy of Professional Coders (AAPC), Natalie is a seasoned professional actively managing medical billing, medical coding, verification, and authorization services at OSI.

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